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General NPI Number Information
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NPI Number | 1417926189
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO FAGOT, INC.
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2929 AVE EMILIO FAGOT
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City | PONCE
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State | PR
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Zip | 00716-3613
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Country | US
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Telephone | 787-843-7555
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Fax | 787-290-0621
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Provider Business Mailing Address
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Address Line | 2929 AVE EMILIO FAGOT
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City | PONCE
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State | PR
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Zip | 00716-3613
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Country | US
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Telephone | 787-843-7555
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Fax | 787-290-0621
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Authorized Official
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Title or Position | MEDICAL TECHNOLOGIST/OWNER
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Name | MRS. JOHANNA MARIE PEREZ
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Credential | BSMT
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Telephone | 787-843-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 621
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License Number State | PR
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